Health Policy:

Immunizations
Tahani Alanazi, Mona Alonazi, Karen Huacasi, Jose Mora,
Fahad Noshili, Nicole Smith
MSNC 512- University of San Diego
 Definition of immunization

The process of inducing immunity to an infectious

organism or agent in an individual through
vaccination.
The recommended immunizations; includes
vaccines against diphtheria, polio, tetanus, measles,
mumps, influenza and rubella.
 Overview of immunization policy

Immunizations are heralded as one of the 20th century's most cost-effective

public health achievements.
Immunizations protect both individuals and the larger population.
Successful immunization programs indicated by high vaccination coverage rates
and low incidences of diseases.
Measles outbreak this year remind us of the important role immunizations play in
the public health system.
Overview of immunization policy

States play a significant role in determining immunization policies.

State legislators face decisions related to increasingly complex vaccine
schedules and recommendations.
State legislators also balance the need to protect the public's health against
the difficulties presented by funding the recommended vaccines.
And, addressing concerns of citizens who may object to mandatory
immunization recommendations.
 Adult Vaccine Recommendations.

Today federal health officials recommend that doctors give adults many
vaccines that were not routinely given to adults in the past. It includes
vaccine such as Hepatitis B, tetanus and varicella, these apply to adults in
certain occupations.
These new adult vaccine recommendations are being turned into legal
mandates as adults working in health, child care and other professions are
being subjected to vaccine requirements as a condition of employment.
 Annual Flu Shots Throughout Life
• The CDC now recommends that all Americans get a flu shot every year
starting at six months old.
• The recommendation that all healthy adults and pregnant women in any
trimester, get an annual flu shot.
• Health care workers are required to take an annual flu shot.
Current Evidence: Federal

• No federal laws mandate vaccination in the United States

• Reccomendations: Advisory Committee on Immunization Practices (ACIP)
• Funding
• Childhood immunizations (VFC) (Section 317 of Public Health Services Act)
• Adult immunizations (Medicare) (Section 317 of Public Health Services Act)
• Vaccine Safety
• National Childhood Vaccine Injury Act (NCVIA)
• National Vaccine Program, National VICP, VAERS
 Current Evidence: State
• States play significant role in determining immunization policies
• Authority and scope of vaccination (California Code, Business and Professions Code 4052.8)
• Requirements for entry into schools (SB-277 Public Health: Vaccinations)
• Requirements in healthcare settings and correctional facilities (California Code of
Regulations, Title 8, Section 5199)
• Requirements for vaccination during a public health emergency (California Health and
Safety Code 101080)
• Medical, religious, and philosophical exemptions (SB-277 Public Health: Vaccinations)
• Minor/ parent consent for immunizations depends on local laws (CA AB-499
Minors: medical care: consent)
• Funding
• Laws and rules vary from state to state
Current Evidence: Local
• Local Public Health Agencies
• Requirements for daycare, school entry, and health care settings (New York City SH-65)
• Quality assurance
• Work to develop effective and coordinated pandemic vaccination plan
• Public Health Emergencies (Commissioner's Order) (New York City Health Code Section 3.01)
• School health care delivery services
• School budgets and priorities set at local level so health services provided vary
• Partner with local health departments to promote vaccination
 Ethical issues: Informed Consent Principle

❖ Consent not Mandatory in the US for parents and adolescent under age of 18
years.
❖ Vaccination is mandatory in all the 50 states for children to go to public school.
❖ There is an exemption and it’s different from state to state:
➢ Medical exemption.
➢ Religious exemption.
➢ philosophical
➢ socioeconomic
 Ethical issues: Informed Consent Principle

● Medical exemption: Some parents think Immunization harmful to their children

applicable to all the states.

● Religious exemption: Some parents refuses the vaccination due to their religion

beliefs. Applicable to 48 states.

● philosophy Exemption: philosophical objections in 20 states

 Connection to class readings/discussions

● social media influence.

● challenges to make informed decision about health.
● No scientific evidence shaking confidence in vaccination yet
● Actions need to be done.
 Connection to class readings/discussions

● What is VFC
● Resurgence of measles at the beginning of the decade and (VFC)
● VFC eligibility criteria:
❖ Children through 18 years
❖ Medicaid eligible
❖ Uninsured and Underinsured
❖ American Indian or Alaska Native
● The state mandates insurance to cover childhood immunization to increase
immunization rate.
 Relationship to clinical practice
Healthcare Providers best clinical practice guidelines
• Education
• Review immunization
• Assess for needed immunizations
• Screen for contradictions and precautions
• Parents who question vaccines
• Vaccine safety
• Understanding risks & responsibilities , if they choose not to vaccinate
(Health Care providers must be vaccinated as well)
 Opportunities for Nursing/Healthcare
Leadership involvement
• Main barriers: access to healthcare, cost, trust, and
perception of safety
• Nurses are healthcare professionals who administer
immunizations and educate patients on them
• Nurses serve a pivotal role in immunization practice
and policy
• Nurses can utilize their unique voice to advocate for
immunizations
 Local
• Education, outreach, health promotion
• Advocate for vaccine reminders in electronic health record
• Local research (Hepatitis A 2018)
• Volunteer/initiate community immunization clinics
• Policy/advocacy: mayor, county executives
• Organizations: HHSA, SDIP, DHHS (SD), Live Well, SDIC
 State

• Policy/Advocacy: governor, senators, representatives

• State-wide standing orders for immunizations
• California Immunization Registry
• Organizations: California DPH, California Immunization Coalition
 Federal

• Nurse champions to explore systemic changes

• Nurse leader for multidisciplinary disease prevention team
• Policy/advocacy: President, Congress
• Government groups that create policy: The Advisory Committee on
Immunization Practices, The National Vaccine Advisory Committee, and
the Vaccines and Related Biological Products Advisory Committee
• Organizations: CDC, DoD, FDA, NIH, NVPC, VICP
 Global

• Global Disease Prevention

• Global Vaccine Action Plan
• Decade of Vaccines
• Organizations: World Health Organization (WHO)
 Group Discussion

● Break into small groups of 4-5 students.

● Discuss the following questions:
○ Think about immunization policies and practices from your hometown.
○ Discuss with others in the group.
■ How do they differ? How are they similar?
■ What is the culture surrounding immunizations there?
■ Does there seem to be a pattern geographically in trends?
 References

American Nurses Association. (n.d.). Policy and Advocacy. Practice and Policy. Retrieved from https://www.nursingworld.org/practice-policy/work-
environment/health-safety/immunize/policy-advocacy/

Basch, C. H., Zybert, P., Reeves, R., & Basch, C. E. (2017). What do popular YouTubeTM videos say about vaccines? Child: Care, Health &
Development, 43(4), 499–503. https://doi-org.sandiego.idm.oclc.org/10.1111/cch.12442

Broniatowski, D. A., Jamison, A. M., Qi, S., AlKulaib, L., Chen, T., Benton, A., … Dredze, M. (2018). Weaponized Health Communication: Twitter
Bots and Russian Trolls Amplify the Vaccine Debate. American Journal of Public Health, 108(10), 1378–1384.
https://doi-org.sandiego.idm.oclc.org/10.2105/AJPH.2018.304567

Chang, L. V. (2016). The Effect of State Insurance Mandates on Infant Immunization Rates. Health Economics, 25(3), 372–386. https://doi-
org.sandiego.idm.oclc.org/10.1002/hec.3153

“Immunizations Policy Issues Overview.” National Conference of State Legislators, National Conference of State Legislators, 17 Jan. 2019,
www.ncsl.org/research/health/immunizations-policy-issues-overview.aspx.

Lindley, Megan C., et al. “The Role of Schools in Strengthening Delivery of New Adolescent Vaccinations.” Pediatrics, vol. 121, Jan. 2008,
doi:10.1542/peds.2007-1115f.
 References
Malone, K. M., & Hinman, A. R. (2003). Vaccination mandates : The public health imperative and individual rights. In Law in public health practice.
Retrieved from https://www.cdc.gov/vaccines/imz-managers/guides-pubs/downloads/vacc_mandates_chptr13.pdf

Macintosh, J.L.B., Eden, L.M., Luthy, K.E., Schouten, A.E. (2017). Global Immunizations Health Promotion and Disease Prevention Worldwide. The
American Journal of Maternal/Child Nursing, 42(3), 139-145. Retrieved from
https://www.nursingcenter.com/journalarticle?Article_ID=4115156&Journal_ID=54021&Issue_ID=4115105

Pager, T., & Mays, J. C. (2019, April 9). New York Declares Measles Emergency, Requiring Vaccinations in Parts of Brooklyn. The New York Times.
Retrieved from https://www.nytimes.com/2019/04/09/nyregion/measles-vaccination-williamsburg.html

Rittle, C. & Francis, R. (2016). The critical role of nurses in promoting immunization for adults. American Nurse Today, 11(9), 42-43. Reitreved from
https://www.americannursetoday.com/wp-content/uploads/2016/09/ANA9-NPW-817.pdf

Swendiman, K. S. & Cole, J.P. Mandatory Vaccinations: Precedent and Current Laws, Congressional Research Service, Library of Congress, 2014.

U.S. Department of Health and Human Services. (2018). More information about vaccines. Vaccines.gov. Retrieved from
https://www.vaccines.gov/resources/more_info/index.html

World Health Organization. (2019). Decade of Vaccines- Global Vaccine Action Plan 2011-2020. Immunization, Vaccines and Bilogicals. Retrieved
from https://www.who.int/immunization/global_vaccine_action_plan/DoV_GVAP_2012_2020/en/